scholarly journals Nerve injury after peripheral nerve blockade—current understanding and guidelines

BJA Education ◽  
2018 ◽  
Vol 18 (12) ◽  
pp. 384-390 ◽  
Author(s):  
D. O'Flaherty ◽  
C.J.L. McCartney ◽  
S.C. Ng
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Current Understanding ◽  
Nerve Blockade ◽  
Peripheral Nerve Blockade

scholarly journals Perioperative Nerve Injury after Total Hip Arthroplasty

2011 ◽  
Vol 115 (6) ◽  
pp. 1172-1178 ◽  
Author(s):  
Adam K. Jacob ◽  
Carlos B. Mantilla ◽  
Hans P. Sviggum ◽  
Darrell R. Schroeder ◽  
Mark W. Pagnano ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Hip Arthroplasty ◽  
Female Gender ◽  
Nerve Blockade ◽  
Neurologic Recovery ◽  
Total Hip ◽  
Peripheral Nerve Blockade ◽  
Clinical Benefits

Background Perioperative nerve injury (PNI) is a recognized complication of total hip arthroplasty (THA). Regional anesthesia (RA) techniques may increase the risk of neurologic injury. Using a retrospective cohort study, the authors tested the hypothesis that use of RA increases the risk for PNI after elective THA. Methods All adult patients who underwent elective THA at Mayo Clinic during a 20-yr period were included. The primary outcome was the presence of a new PNI within 3 months of surgery. Multivariable logistic regression was used to evaluate patient, surgical, and anesthetic risk factors for PNI. Results Of 12,998 patients undergoing THA, 93 experienced PNI (incidence = 0.72%; 95% CI 0.58-0.88%). PNI was not associated with type of anesthesia (OR = 0.72 for neuraxial-combined vs. general; 95% CI 0.46-1.14) or peripheral nerve blockade (OR = 0.65; 95% CI 0.34-1.21). The risk for PNI was associated with younger age (OR = 0.79 per 10-yr increase; 95% CI 0.69-0.90), female gender (OR = 1.72; 95% CI 1.12-2.64), longer operations (OR = 1.10 per 30-min increase; 95% CI 1.03-1.18) or posterior surgical approach (OR = 1.91 vs. anterior approach; 95% CI 1.22-2.99). Neurologic recovery was not influenced by the use of RA techniques in patients with PNI. Conclusions The risk for PNI after THA was not increased with the use of neuraxial anesthesia or peripheral nerve blockade. Neurologic recovery in patients who experienced PNI was not affected by the use of RA. These results support the use of RA techniques in patients undergoing elective THA given their known functional and clinical benefits.

scholarly journals Perioperative Nerve Injury after Total Knee Arthroplasty

2011 ◽  
Vol 114 (2) ◽  
pp. 311-317 ◽  
Author(s):  
Adam K. Jacob ◽  
Carlos B. Mantilla ◽  
Hans P. Sviggum ◽  
Darrell R. Schroeder ◽  
Mark W. Pagnano ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Knee Arthroplasty ◽  
Outcome Variable ◽  
Tourniquet Time ◽  
Nerve Blockade ◽  
Neurologic Recovery ◽  
Peripheral Nerve Blockade ◽  
Total Knee

Background Perioperative nerve injury (PNI) is one of the most debilitating complications after total knee arthroplasty (TKA). Although regional anesthesia (RA) techniques reduce pain and improve functional outcomes after TKA, they may also contribute to PNI. The objective of this study was to test the hypothesis that PNI risk differs among patients according to RA use during TKA. Methods All patients aged at least 18 yr who underwent elective TKA from January 1988 to July 2007 were retrospectively identified. The primary outcome variable was the presence of a new PNI documented within 3 months of the procedural date. Age, sex, body mass index, type of procedure, tourniquet time, type of anesthesia, and use of peripheral nerve blockade were evaluated as potential risk factors for PNI using multivariable logistic regression. Results Ninety-seven cases of PNI were identified among 12,329 patients. Overall incidence of PNI was 0.79% (95% CI, 0.64-0.96%). PNI was not associated with peripheral nerve blockade (odds ratio [OR], 0.97) or type of anesthesia (OR, 1.10 [neuraxial vs. general]; OR, 1.82 [combined vs. general]). Risk for PNI decreased with age (OR, 0.68 [per decade]; P < 0.001) but increased with tourniquet time (OR, 1.28 [per 30-min increase]; P = 0.003) and bilateral procedures (OR, 2.51; P < 0.001). Patients with PNI who underwent peripheral nerve blockade were less likely to have complete neurologic recovery (OR, 0.37; P = 0.03). Conclusions Risk for PNI after TKA was unchanged by the use of RA techniques. This finding supports the notion that the known benefits of RA for patients undergoing TKA can be achieved without increasing risk of neurologic injury. However, in rare situations when PNI occurs, complete recovery may be less likely if it develops after peripheral nerve blockade.

Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade

2015 ◽  
Vol 40 (5) ◽  
pp. 479-490 ◽  
Author(s):  
Richard Brull ◽  
Admir Hadzic ◽  
Miguel A. Reina ◽  
Michael J. Barrington
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Nerve Blockade ◽  
Peripheral Nerve Blockade

Lower-extremity peripheral nerve blockade: Essentials of our current understanding

2005 ◽  
Vol 30 (1) ◽  
pp. 4-35 ◽  
Author(s):  
F ENNEKING ◽  
V CHAN ◽  
J GREGER ◽  
A HADZIC ◽  
S LANG ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Peripheral Nerve ◽  
Current Understanding ◽  
Nerve Blockade ◽  
Peripheral Nerve Blockade

Predictors of hospital admission after rotator cuff repair: the role of peripheral nerve blockade

2013 ◽  
Vol 30 ◽  
pp. 135-136
Author(s):  
O. Stundner ◽  
T. Danninger ◽  
R. Rasul ◽  
M. Mazumdar ◽  
P. Gerner ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Peripheral Nerve ◽  
Hospital Admission ◽  
Rotator Cuff Repair ◽  
Nerve Blockade ◽  
Peripheral Nerve Blockade ◽  
Cuff Repair

scholarly journals Cardiac Arrest due to Failed Pacemaker Capture After Peripheral Nerve Blockade With Levobupivacaine: A Case Report

2021 ◽  
Vol 15 (4) ◽  
pp. e01445
Author(s):  
Asuka Kitajima ◽  
Takeshi Nakatomi ◽  
Yuji Otsuka ◽  
Masamitsu Sanui ◽  
Alan Kawarai Lefor
Keyword(s):  
Cardiac Arrest ◽  
Case Report ◽  
Peripheral Nerve ◽  
Nerve Blockade ◽  
Peripheral Nerve Blockade

Anatomical Considerations for Peripheral Nerve Blockade

2010 ◽  
pp. 51-94
Author(s):  
James R. Hebl
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Surface Orientation ◽  
Lumbar Plexus ◽  
Lumbosacral Plexus ◽  
Motor Innervation ◽  
Nerve Blockade ◽  
Peripheral Nerve Blockade

Chapter 5 contains a basic review of terminology used to describe body planes, surface orientation, and movements. The anatomy of major nerve plexuses are also examined: brachial plexus, lumbar plexus, lumbosacral plexus. The chapter concludes with a discussion of peripheral nerve anatomy and sensory and motor innervation, including dermatomes, osteotomes, and myotomes.

scholarly journals Az ultrahang-képalkotás alkalmazása biotechnikai előrelépés a perioperatív fájdalomcsillapításban

2019 ◽  
Vol 160 (15) ◽  
pp. 573-584
Author(s):  
Róbert Gyula Almási
Keyword(s):  
Nervous System ◽  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
Peripheral Nerve ◽  
General Anaesthesia ◽  
Central Sensitization ◽  
Regional Anaesthesia ◽  
Nerve Blockade ◽  
Peripheral Nerve Blockade

Abstract: The perioperative pain management – instead of the efforts, guidelines and protocols – is underestimated and undertreated. Even in the case of general anaesthesia, the nervous system is overwhelmed by copious quantities of nociceptive stimuli at surgical incision. Stress and pain-modulation processes are triggered which can have significant influence on the outcome. Often the pain-management is discontinued, so a notable part of patients complain about pain in the ward after surgery. Regional anaesthesia conceptually prevents noxious inputs to enter the central nervous system, beyond surgical anaesthesia it is pertinent to achieve excellent analgesia in the immediate postoperative period as well. Based on current literature, this paper provides an overview of the history and role of regional anaesthesia in the multidimensional model of pain. Besides the sensitization caused by nociceptive stimuli – peripheral and central sensitization, descending modulation – there are several biopsychosocial factors involved in pain pathophysiology. Preventing the side effects of general anaesthesia, the ultrasound-guided peripheral nerve blockade is a safe technique with high success rate, rare side effects, achieving long-lasting, excellent analgesia. Continuous perineural catheter placed under ultrasound provides extended pain control. As a part of multimodal analgesia, peripheral nerve blockade prevents central sensitization. After surgery, the pain intensity of patients under peripheral nerve blockade is less, the chronification tendency is decreased, the quality of life and patients’ comfort are improved, and the stress-response is attenuated. The greater part of patients are protected from the undesirable side effects of general anaesthesia. Nowadays, it is an unequivocal evidence that the increasingly used peripheral nerve blockades prior to incision are efficient tools in the prevention of chronic postoperative pain. Ultrasound guidance is suitable not only for surgical anaesthesia, but for postoperative pain management as well, however, besides economic factors, the main goal of this technique is to match the best interest of the patients. Orv Hetil. 2019; 160(15): 573–584.

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